Lung volume reduction surgery for emphysema

As a surgical treatment for end-stage emphysema, lung volume reduction surgery began in the mid-1990s, which opened up a new way for the treatment of emphysema and achieved a more accurate clinical effect. The time for lung volume reduction surgery is still short. It is important to master the indications for lung volume reduction surgery and to choose the best surgical method. Common surgical methods for lung volume reduction include bilateral sternal incision bilateral lung volume reduction, thoracoscopic lung volume reduction surgery, and conventional posterolateral incision unilateral lung volume reduction surgery. VATS lung volume reduction surgery is characterized by minimally invasive surgery and is more suitable for patients with severe emphysema with poor cardiopulmonary function. Treatment of diseases: emphysema Indication End stage emphysema. Surgical procedure Position Unilateral thoracoscopic lung volume reduction surgery was performed in the lateral position. When bilateral thoracoscopic surgery was performed, the position was changed after one side of the operation to perform contralateral surgery. 2. Incision The position of the thoracoscopic cannula is selected from the midline of the iliac crest to the 7th or 8th intercostal space of the posterior tibial line. The other 2nd to 4th instrumentation cannula is determined according to the lesion. Two of the operation cannula are usually selected in the anterior iliac crest. The fourth intercostal space and the seventh intercostal space of the posterior iliac crest. 3. Selection of lung volume reduction site After the endoscopic cannula was placed, a "target area" with severe emphysema was selected by thoracoscopy. The selection of the "target area" was combined with preoperative chest CT and isotope lung ventilation and perfusion imaging. 4. Pulmonary resection After the target area of the diseased lung to be resected is selected, the separation forceps or scissors are placed through the operation port to loosen all the adhesions in the thoracic cavity, the lung ligament is broken, and the lung puller is placed from the rear operation port to prepare for resection. The lung tissue was inserted into the endoscopic suture cutter with a bovine pericardium from the anterior side operation hole, and the lung tissue to be excised was clipped, and the hair was cut to complete a cutting. The next clipping cut is then performed, and each lung cutting edge should overlap each other until the target area is removed. The extent of lung resection is about 20% to 30% of the capacity of one side of the lung, and the remaining lung morphology is similar to that of the thoracic shape. The lung volume reduction surgery is over. Intrathoracic fluid was injected into the thoracic cavity, and the lungs were ventilated to check for air leaks. Thoracoscopy monitors the intercostal nerve closure. The closed drainage tube was placed through two cannula ports, one placed on the top of the pleura and the other placed on the rib angle. complication Air leak Air leak is the most common complication, and its incidence is about 40% to 50%. It often occurs at the junction of the lung cutting edge and the surface of the lung where the adhesion is loosened. Note: 1 Care should be taken when separating the pleural adhesions. If it is ruptured, it should be sutured with an endoscopic suture cutter with a bovine pericardium or with a burr pericardium; 2 each lung should have an appropriate overlap. 2. Respiratory insufficiency End-stage emphysema is a chronic respiratory disease. The general condition of the patient is poor. It is prone to carbon dioxide retention, respiratory insufficiency and respiratory failure after surgery. The management of the respiratory tract is very important, including the removal of endocrine secretions before intubation of the tracheal intubation, encourage coughing after surgery, assist with sputum excretion, and if necessary, suction through a nasal cannula or fiberoptic bronchoscope. Keeping the drainage tube open, controlling the amount of liquid and selecting the appropriate antibiotics are also important measures.